Shining a Light on Gambling: The Hidden Addiction

What does problem gambling look like?

“Problem gambling, also known as gambling addiction or gambling disorder, occurs when a person is unable to resist impulses to gamble and continues to gamble despite harmful consequences. Gambling disorder is classified as an addiction and its essential features include loss of control over gambling, preoccupation with gambling, increasing need to bet more money, and an inability to stop or cut back gambling. In severe cases, gambling disorder can result in financial ruin, legal problems, loss of career or family, and even suicide.” 

It is important to understand that gambling addiction impacts many aspects of the problem gambler’s life.  This includes the immense pressures that financial losses can bring about. Gambling can also result in time spent away from family and friends, a loss of interest in life activities, and an increased tolerance towards gambling (e.g., the need to bet more to gain the same excitement that was previously felt). The gambler will often feel compelled to lie and manipulate to conceal the extent of the gambling behaviors or losses. 

Looking at the impact of gambling on one’s mental health is critical because the negative impacts of gambling may challenge one’s ability to regulate emotions and mood, and limit one’s ability to disengage from a negative addictive cycle.  An increase in feelings of shame, guilt, anxiety, and depression can push one into greater isolation wherein gambling becomes the only focus, and the cycle begins again.  

Getting treatment to break the cycle of addictive behavior is essential to regain a sense of wellbeing in one’s life.  It is important to remember that addiction thrives in isolation. It is connection and relationships that make positive life change possible.  Reach out and make change a part of your life.

[1] McCown G., William and Howatt A., William: Treating Gambling Problems: Copyright 2007, John Wiley & Sons., Inc., Pages 4-6 

[2] Training material for CalGets Gambling addiction provider program “Individualized Treatment for Problem Gamblers.” 

Am I Covered?: What to know about your insurance coverage for mental health services

As the primary insurance analyst for Roubicek & Thacker Counseling, I have come across a variety of insurance companies, third-party administrators, rates, plans and coverages. Here are some insider tips for you -- things to know ahead of time when considering using your insurance to help pay for your mental health services:

Know Before You Go

Check your personal or family mental health coverage by calling the number on the back of your insurance card, or by logging in to your account on the insurance provider’s website. If you choose to call (recommended), be sure to have your card handy because they’ll ask you for your member or subscriber number, and likely your birthdate. Once they verify who you are, begin by asking the member service representative, “Do I have mental health coverage?”

When the customer service representative outlines your benefits, make note of your yearly deductible and how much of that deductible has already been met. Most insurance coverage will not come into effect until after the deductible has been met. It would also be a good idea to ask them about your copay.

In-Network

Next, say, “I would like to see __________ (counselor) at Roubicek & Thacker. Are they an in-network or out-of-network provider?”

If the counselor or group is in-network, it means that the insurance company has a contract with that counselor to offer services to their members at specific rates. There is likely a greater percentage of the rate covered by the insurance company if the provider you would like to see is in-network.

“What is my in-network coverage for mental health, out-patient, office visits?” If you ask for exactly how much the insurance will pay, the representative will likely only offer a percentage of the allowed amount. Rarely do they offer an exact dollar amount.

If you plan on enrolling in one of our programs, LifeStar or LifeStyle Transformation, know that these programs primarily consist of weekly group sessions. Ask, “Am I covered for group sessions?” If yes, then you’re good to go, and may only have to pay until your deductible is met and possibly a per-session copay.

For family or couple sessions, ask, “Do I have coverage for family or couple sessions?” If so, then your insurance will help cover those costs, again, after the deductible is met, and you may still have a copay.

Out-of-Network

    Some insurance companies, based on your plan’s coverage and benefits, do not cover out-of-network mental health services. In that case, you would be responsible for the full cost of services, or may need to reference the insurance company’s list of in-network providers (sometimes called “preferred providers”) to find a counselor who is in-network.

It would also be a good idea to ask them about your copay. If they offer a percentage as copay, it may mean that you are responsible not only for the copay, but also for the remainder of the full charge after insurance has been paid. For example, say the full charge is $125 and the copay on your card states $20 is due at the time of service, so you pay it. Then, six weeks later, the insurance company pays $75. So now, $95 has been paid, but there’s a remaining balance of $30. That remaining $30 is also your responsibility. At the end of the story you have paid a total of $50 out-of-pocket, and insurance has covered the $75, equaling the total $125 charge.

What did they say? Common insurance lingo in layman’s terms:

  • Allowed amount: the amount recognized by the insurance company that is allowed for such services in this region. (This is where it gets tricky if your member representative tells you you only owe 10% of the allowed amount. That would be final if in-network, but when out-of-network you would owe the 10% and anything else the insurance company didn’t cover of the full charge. *see last paragraph of the Out-of-Network section above)
  • Benefits: The benefits are just that, benefits. You select a plan and pay for it. If you selected a plan with mental health benefits, then great, you’re covered!
  • Copay: for in-network coverage, it is the amount you pay out-of-pocket for each visit; typically a consistent amount
  • Coverage: the benefits included in your purchased plan
  • Current Procedural Terminology: see Service Code
  • Deductible: the amount you must have billed the insurance company for, and paid out-of-pocket before your coverage kicks in
  • Diagnosis: the terminology, definition, and code that specifies the problem or issue that brought you in for therapy. It allows the counselor to know how to best help you, and the insurance company to know whether they will cover the services or not (see also, Parity Diagnosis)
  • Eligibility: the services you are authorized to receive as included in your plan
  • Explanation of Benefits (EOB): a document that comes in response to an insurance claim submission outlining the date(s) of service, service code (i.e., individual, group, or family session), allowed amount, copay, deductible, payment amount, and other such information.
  • In-network: the counselor has signed a contract to be considered a “preferred” provider with that insurance company
  • Member: You! The person paying for, or listed as covered by, the plan
  • Out-of-network: the counselor has not signed a contract with your insurance company to accept their rates for services rendered
  • Parity Diagnosis: “The Mental Health Parity and Addiction Equity Act (MHPAEA) requires health care service plans that offer coverage for mental health or substance use disorders (MH/SUD) to provide the same level of benefits that they do for general medical treatment” (dmhc.ca.gov). According to The Mental Health Parity and Addiction Equity Act of 2008, the diagnoses that are equal to other medical coverage are listed here.
  • Plan, insurance: the product you’re paying for as sold to you by the insurance company
  • Preferred Provider: another way of saying that said counselor is in-network with a particular insurance company
  • Provider: the licensed counselor or group of counselors rendering mental health services
  • Rates: the dollar amounts charged/paid
  • Service Code: a five digit numerical insurance code that represents the type of service rendered (i.e., 90834 is code for an individual psychotherapy session); also called a Current Procedural Terminology (CPT) code
  • Superbill: *only available when the provider is out-of-network with your insurance company* a document, like a detailed receipt, listing your date(s) of service, diagnosis, service codes, amount you’ve paid for the services, and the provider’s signature; submit this to your insurance company as a claim, and they will reimburse you directly according to your plan’s benefits
  • Third-party Administrator: The most common one I can think of is that Magellan or Mental Health Services Administrators. Third-party administrators process the mental health claims for larger insurance companies like Blue Shield of California. There may be different in- or out-of-network statuses for these administrators (i.e. the provider may be in network with Blue Shield of California, but not with Magellan).

*Note: Insurance cannot be billed, nor would insurance pay, for services rendered by an intern or associate therapist.

It comes down to your plan.

 The plan you pay for on a monthly, semi-annual, or yearly basis determines the coverage you have. If you have further questions, first, call your insurance company then call us here at the office with any questions.


How The Brain Gets Addicted To Gambling

Addictive drugs and gambling rewire neural circuits in similar ways.

Gambling had been part of the American culture since the early 1800’s. At fist glance gambling often appears to be a harmless form of entertainment, or at worst, a lesser vice.  However, for individuals that become problem or pathological gamblers it can be catastrophic.  Through this often “hidden addiction” affected individuals will often lose everything: family, friends, and any financial security they might once have had (e.g., home, savings, retirement). 

Recently, the American Psychiatric Association that oversees the diagnoses of gambling has reclassified from a compulsive disorder to an addiction disorder.  The treatment of compulsive and addiction disorders are handled very differently. Addictive gambling disorder therapy treatment may be much more intensive than that of compulsive disorders.  

A recent article in the journal Scientific American: How the Brain Gets Addicted to Gambling:Addictive drugs and gambling rewire neural circuits in similar ways, sheds light on the brain process. With greater understanding there can be more promising outcomes for treatment. 

The Last of the Human Freedoms

Viktor Frankl (1905-1997) was a neurologist and psychiatrist from Austria who survived the horrors of the Holocaust. In his book, Man’s Search for Meaning he writes of his experience in a  concentration camp in Auschwitz where he would be witness to most degrading of human behavior. There he would lose his mother, brother and his wife Tilly.

Through this horrible experience, he observed fellow prisoners around him and how they coped with an unbearable environment, grief and multiple losses. He came to learn an important principle which, when integrated into our own belief system, can help us to overcome and grow despite the most difficult of odds. He wrote:

“Everything can be taken from a man (or woman) but one thing: the last of the human freedoms- to choose one’s attitude in any given set of circumstances”.

The problem with addiction is that it takes away our willpower to make healthy choice. It fills us up with lies. Lies like “You can’t do it!”, “You never last more than a few days, just give up!” and “You are too weak, you don’t have enough willpower!” And when you believe the lies, they become your truth. But there is a freedom that addiction cannot take. It cannot take away your freedom to choose how you are going to respond to the lies of addiction. Just like Viktor Frankl, you can recognize that you do still have the last of the human freedoms - to choose how you will respond. You can listen and embrace truth rather than the lies! And the truth is that you can do it! And when you fall, you can get up and try again. Success isn’t measure by the accomplishment as much as it is measured by your choice to keep going!

Check out this great video clip of Heather Dornidan, who fell, got up, tried again and went on to victory. And you can too!